NPI | 1831546266 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: UT 9668264-6004) |
Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: UT 9668264-6009) |
Enumeration Date | 2016-05-16 |
Last Update Date | 2019-05-16 |