| NPI | 1174187322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 68348) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11362) |
| 101YP2500X Counselor, Professional (Licence: TX 68348) | |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2019-04-23 |