| NPI | 1144525320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 62333) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11059) |
| 101YM0800X Counselor, Mental Health (Licence: TX 62333) | |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2011-01-19 |