| NPI | 1053472969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX LPC 16662) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX AAC 1128-0080) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2012-02-13 |