| NPI | 1689497109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 14393) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 101Y00000X Counselor | |
| Enumeration Date | 2024-11-04 |
| Last Update Date | 2024-11-04 |