| NPI | 1982914628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 80995) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61309834) |
| 101YP2500X Counselor, Professional (Licence: MO 2021025677) | |
| 101YP2500X Counselor, Professional (Licence: WI 5230-125) | |
| 101YP2500X Counselor, Professional (Licence: VA 0701009304) | |
| 101YP2500X Counselor, Professional (Licence: LA 4204) | |
| 103TS0200X Psychologist, School (Licence: LA AN 475286) | |
| 103TS0200X Psychologist, School (Licence: MS 200902) | |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2024-06-27 |