| NPI | 1235586785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 83631) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 10461) |
| 101YP2500X Counselor, Professional (Licence: TX 83631) | |
| Enumeration Date | 2016-05-14 |
| Last Update Date | 2024-05-02 |