| NPI | 1750300299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 785) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 08862) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-08 |