| NPI | 1932541315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 10844181-6004) |
| Additional Taxonomies | 253J00000X Foster Care Agency |
| 101YM0800X Counselor, Mental Health (Licence: UT 10844181-6009) | |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2023-10-04 |