| NPI | 1376811778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 66780) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11358) |
| 104100000X Social Worker (Licence: TX 36440) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 201655) | |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2012-04-25 |