NPI | 1912139353 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 65074) |
Additional Taxonomies | 101Y00000X Counselor (Licence: TX 65074) |
101YM0800X Counselor, Mental Health (Licence: TX 65074) | |
Enumeration Date | 2009-08-19 |
Last Update Date | 2013-05-28 |