NPI | 1790022044 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 69361) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0145391) |
Enumeration Date | 2013-01-07 |
Last Update Date | 2013-07-05 |