| NPI | 1255404257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 3152) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 8753) |
| 1041C0700X Social Worker, Clinical (Licence: TX 10754) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 614) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2007-07-08 |