| NPI | 1346533775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 14330) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 14330) |
| 101YP2500X Counselor, Professional (Licence: TX 14330) | |
| 102L00000X Psychoanalyst (Licence: TX 14330) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 14330) | |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2012-11-01 |