| NPI | 1366808537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 72311) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 12108) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2016-01-04 |