NPI | 1255140356 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R10808) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 97035) |
Enumeration Date | 2025-01-03 |
Last Update Date | 2025-02-28 |