| NPI | 1447622246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 70679) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 70679) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 70679) | |
| 101YM0800X Counselor, Mental Health (Licence: TX 70679) | |
| 101YP1600X Counselor, Pastoral (Licence: TX 70679) | |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2016-09-14 |