| NPI | 1699412676 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 77161) | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 77161) | 
| 101Y00000X Counselor (Licence: TX 77161) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 77161) | |
| Enumeration Date | 2022-05-19 | 
| Last Update Date | 2025-09-14 |