NPI | 1013064401 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 10274) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 10274) |
Enumeration Date | 2007-01-05 |
Last Update Date | 2020-07-06 |