| NPI | 1558679399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701008180) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0701008180) |
| 101YM0800X Counselor, Mental Health (Licence: VA 0701008180) | |
| 101YP2500X Counselor, Professional (Licence: TX 61633) | |
| 101YS0200X Counselor, School (Licence: TX 61633) | |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2023-11-29 |