| NPI | 1922862291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 10046) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 100074) |
| 101Y00000X Counselor | |
| 101Y00000X Counselor (Licence: TX 100074) | |
| Enumeration Date | 2024-02-07 |
| Last Update Date | 2025-09-09 |