| NPI | 1336203504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 1204) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 16764) |
| 106H00000X Marriage & Family Therapist (Licence: TX 001298-042491) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2007-07-08 |