| NPI | 1487783239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 62101) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 10321) |
| 101YM0800X Counselor, Mental Health (Licence: TX LPC) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2010-12-21 |