| NPI | 1043759285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 273669-3902) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 273669-3902) |
| 101YM0800X Counselor, Mental Health (Licence: UT 273669-3902) | |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2017-02-21 |