| NPI | 1750319604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX S31242) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX S31242) |
| 1041C0700X Social Worker, Clinical (Licence: TX S31242) | |
| 106H00000X Marriage & Family Therapist (Licence: TX S31242) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2008-06-30 |