| NPI | 1063013985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 84481) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 15492) |
| 101YM0800X Counselor Mental Health (Licence: TX 84481) | |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2023-03-31 |