NPI | 1720563737 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 13246) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 80392) |
Enumeration Date | 2018-09-26 |
Last Update Date | 2018-09-26 |