| NPI | 1669719597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 67618) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 67618) |
| 101YM0800X Counselor, Mental Health (Licence: TX 67618) | |
| 102L00000X Psychoanalyst (Licence: TX 67618) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 67618) | |
| Enumeration Date | 2013-01-11 |
| Last Update Date | 2021-08-08 |