| NPI | 1952021966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 85331) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC01141700.) |
| 101YM0800X Counselor, Mental Health (Licence: TX 85331) | |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2026-03-27 |