| NPI | 1245970250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 13438) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 77435) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2022-03-29 |