| NPI | 1376566877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 19755) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701012693) |
| 103T00000X Psychologist (Licence: MI 6361007890) | |
| 251B00000X Case Management (Licence: TX 140075) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 12725) | |
| 101YP2500X Counselor, Professional (Licence: TX 19755) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2025-12-19 |