| NPI | 1457884371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX LCDC 9007) |
| 106H00000X Marriage & Family Therapist (Licence: TX LPC 16268) | |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2020-06-10 |