| NPI | 1104935725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 1240) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 03383) |
| 106H00000X Marriage & Family Therapist (Licence: TX 001481-040679) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |