NPI | 1588166755 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 75981) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 75981) |
Enumeration Date | 2018-03-05 |
Last Update Date | 2025-09-18 |