| NPI | 1124823877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 91125) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: TX 91125) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2025-02-17 |
| Last Update Date | 2025-09-30 |