| NPI | 1104017854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 3649) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 4007) |
| 104100000X Social Worker (Licence: TX 08798) | |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2007-08-07 |