| NPI | 1922437177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 8563806-6009) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 8563806-6004) |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2019-02-04 |