| NPI | 1619900933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP1600X Counselor, Pastoral | |
| 106H00000X Marriage & Family Therapist (Licence: TX 003490) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2007-07-09 |