NPI | 1588111751 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 89067) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 6633) |
Enumeration Date | 2016-09-06 |
Last Update Date | 2024-10-21 |