NPI | 1174536619 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0205461) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 16736) |
Enumeration Date | 2006-08-14 |
Last Update Date | 2019-08-14 |