| NPI | 1194868950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 59576) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 8649) |
| 101YM0800X Counselor, Mental Health (Licence: TX 59576) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2007-09-06 |