NPI | 1700413523 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX LPC94424) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LPCC11325) |
Enumeration Date | 2020-03-23 |
Last Update Date | 2024-04-01 |