| NPI | 1316233679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 16404) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: TX 1-11-8707) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2024-05-28 |