| NPI | 1760972178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: UT 122885986004) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 122885986004) |
| 101YM0800X Counselor, Mental Health (Licence: UT 122885986004) | |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2022-06-23 |