NPI | 1972014173 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 74328) |
Additional Taxonomies | 101Y00000X Counselor (Licence: TX 74328) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 74328) | |
101YP2500X Counselor, Professional (Licence: TX 74328) | |
Enumeration Date | 2017-10-16 |
Last Update Date | 2017-10-16 |