| NPI | 1356717201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TX 17630) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 17630) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 17630) | |
| 101YP2500X Counselor Professional (Licence: TX 17630) | |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2015-09-08 |