| NPI | 1790752319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 16245) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 16245) |
| 101Y00000X Counselor (Licence: TX 16245) | |
| 101YM0800X Counselor Mental Health (Licence: TX 16245) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2007-07-09 |