| NPI | 1356975825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 77849) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 14558) |
| 101YM0800X Counselor, Mental Health (Licence: TX 77849) | |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2022-02-26 |