NPI | 1184333510 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 86636) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 15762) |
101YM0800X Counselor, Mental Health (Licence: TX 86636) | |
Enumeration Date | 2022-11-15 |
Last Update Date | 2022-11-15 |