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 |