| NPI | 1780740480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 3058) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 10202) |
| 1041C0700X Social Worker, Clinical (Licence: TX 10202) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 627-000621) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2007-07-08 |