| NPI | 1003606369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 92907) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 55795) |
| 101YM0800X Counselor, Mental Health (Licence: TX 92907) | |
| Enumeration Date | 2025-05-09 |
| Last Update Date | 2025-05-21 |