| NPI | 1629440763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 71836) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 71836) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 12273) | |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2023-06-28 |