NPI | 1124417340 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 70767) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 70767) |
Enumeration Date | 2015-01-12 |
Last Update Date | 2024-07-09 |