| NPI | 1740918010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 85464) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2022-12-22 |