| NPI | 1346446739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TX 59451) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 25091) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2007-08-30 |