| NPI | 1306144845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 20319) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 20319) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 9873) | |
| 101YP1600X Counselor Pastoral (Licence: TX 123111) | |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2011-03-08 |