| NPI | 1649647769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 88209) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 16323) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2023-08-24 |