| NPI | 1821011610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 1652) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 9588) |
| 106H00000X Marriage & Family Therapist (Licence: TX 2983) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2025-09-11 |