| NPI | 1285889634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 67531) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 9583) |
| 106H00000X Marriage & Family Therapist (Licence: TX 202608) | |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2022-09-14 |