| NPI | 1518274745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 64286) |
| 101YM0800X Counselor Mental Health (Licence: TX 64286) | |
| 101YP2500X Counselor Professional (Licence: TX 64286) | |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2012-08-29 |