| NPI | 1720564768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 64968) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 64968) |
| 101YP2500X Counselor, Professional (Licence: TX 64968) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 64698) | |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2026-01-31 |