| NPI | 1235337445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 63847) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 317L) |
| 101YP2500X Counselor, Professional (Licence: AR P1206071) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2024-11-21 |