| NPI | 1619421781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 64638) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 10986) |
| 106H00000X Marriage & Family Therapist (Licence: TX 201609) | |
| Enumeration Date | 2016-08-06 |
| Last Update Date | 2016-08-06 |