| NPI | 1437468600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 75908) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2023-10-20 |