| NPI | 1740359926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701003908) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710102016) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11875) | |
| 101YP2500X Counselor, Professional (Licence: TX 70174) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2020-09-10 |