| NPI | 1184215766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 41484) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 41484) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: TX 41484) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: TX 41484) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: TX 41484) | |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2021-01-27 |