NPI | 1669556833 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 3575) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 6308) |
101YP2500X Counselor, Professional (Licence: TX 09198) | |
Enumeration Date | 2006-10-25 |
Last Update Date | 2025-09-11 |