NPI | 1003621525 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 88147) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 88147) |
Enumeration Date | 2025-02-11 |
Last Update Date | 2025-02-12 |