| NPI | 1003228388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 82232) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PA 10046) |
| 101YM0800X Counselor Mental Health (Licence: PA PC009517) | |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2019-12-05 |