| NPI | 1730626623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 74639) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 12579) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303146) | |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2017-01-30 |