| NPI | 1174755235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 3625) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 1526-1000) |
| 101Y00000X Counselor (Licence: TX F17929) | |
| 104100000X Social Worker (Licence: TX 22770) | |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2010-10-24 |