NPI | 1376090852 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 69069) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 4504) |
101YM0800X Counselor, Mental Health (Licence: TX 69069) | |
Enumeration Date | 2016-09-01 |
Last Update Date | 2023-12-04 |