| NPI | 1114119211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 67001) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 10252) |
| 104100000X Social Worker (Licence: TX 36555) | |
| 102L00000X Psychoanalyst (Licence: TX 67001) | |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2010-12-21 |