| NPI | 1982390910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C11130) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 21519) |
| 101YM0800X Counselor, Mental Health (Licence: TX 80398) | |
| 101YP2500X Counselor, Professional (Licence: TX 80398) | |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2026-04-08 |