| NPI | 1528249190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 69402) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 9296) |
| 101YM0800X Counselor, Mental Health (Licence: NY 476-1) | |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2016-09-26 |