NPI | 1194199208 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 96952) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 7635) |
101YM0800X Counselor, Mental Health (Licence: TX 96952) | |
Enumeration Date | 2015-12-01 |
Last Update Date | 2025-10-03 |