| NPI | 1821577628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 71752) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 12272) |
| 101YM0800X Counselor, Mental Health (Licence: CO LPC.0014807) | |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2018-08-13 |