NPI | 1679546642 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA 839) |
Additional Taxonomies | 101Y00000X Counselor (Licence: TX 199954LPC) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 5637) | |
Enumeration Date | 2006-02-09 |
Last Update Date | 2025-09-11 |