| NPI | 1306366539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 13939) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 77424) |
| 101YP1600X Counselor Pastoral | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2022-07-21 |