| NPI | 1659438703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 14357 (LPC)) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN C1124 (CADAC IV)) |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2012-04-20 |