| NPI | 1740768563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 201956) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11850) |
| 101YM0800X Counselor, Mental Health (Licence: TX 70420) | |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2018-08-02 |