| NPI | 1598799074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 5965) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 84794) |
| 101Y00000X Counselor (Licence: TX 84794) | |
| 101YP2500X Counselor, Professional (Licence: TX 84794) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2025-10-03 |