| NPI | 1770026064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 13650) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: 00016288) |
| 101YM0800X Counselor Mental Health (Licence: TX 14150426) | |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2020-10-06 |