| 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 |