| NPI | 1083818256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC11365) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 63996) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 63996) | |
| 101YM0800X Counselor, Mental Health (Licence: TX 63996) | |
| 101YP2500X Counselor, Professional (Licence: TX 63996) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2024-10-10 |