| NPI | 1780458604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TX 88572) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 88572) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 16133) | |
| Enumeration Date | 2023-11-10 |
| Last Update Date | 2025-10-31 |