| NPI | 1194048926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 9710) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 94250) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 3590) | |
| 101YM0800X Counselor, Mental Health (Licence: TX 12730) | |
| 103TS0200X Psychologist, School (Licence: TX 6770) | |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2010-03-08 |