| NPI | 1992733794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 27442) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM C-09288) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2024-11-25 |