| NPI | 1477820132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 86294) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1204) |
| 101YP2500X Counselor, Professional (Licence: LA 5018) | |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2023-11-08 |