| NPI | 1013906825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 2677) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 2950) |
| 1041C0700X Social Worker, Clinical (Licence: TX 11277) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 1277) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2007-07-08 |