| NPI | 1083073068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 4280 A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 8262) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 901) | |
| 225700000X Massage Therapist (Licence: TX MT105186) | |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2016-02-19 |