| NPI | 1972828689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 65222) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T-0129941) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2024-11-08 |