| NPI | 1639404783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 63106) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 6861) |
| 1835N1003X Pharmacist, Nutrition Support (Licence: TX 26149) | |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2021-06-03 |