| NPI | 1518016450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AR 2415-C) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 144) |
| 101YP2500X Counselor Professional (Licence: TX 8921) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 0001000-000091) | |
| 101YM0800X Counselor Mental Health (Licence: TX 98422) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2010-01-12 |