| NPI | 1124184312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 7776) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 724) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2007-09-20 |