| NPI | 1548580863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 73819) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 1532) |
| 101YP2500X Counselor, Professional (Licence: TX 73819) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2024-04-26 |