| NPI | 1730995747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 96966) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 96966) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 96966) | |
| Enumeration Date | 2024-12-04 |
| Last Update Date | 2024-12-11 |