NPI | 1740456805 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 17033) |
Additional Taxonomies | 104100000X Social Worker (Licence: TX 17033) |
103K00000X Behavior Analyst (Licence: TX 17033) | |
101Y00000X Counselor (Licence: TX 17033) | |
Enumeration Date | 2008-05-07 |
Last Update Date | 2011-01-19 |