| NPI | 1922541762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: TX 00174746) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 00174746) |
| 101Y00000X Counselor (Licence: TX 76800) | |
| 101YM0800X Counselor, Mental Health (Licence: TX 76800) | |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2020-08-28 |