| NPI | 1831383413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 66119) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 0071041) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 7919) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2010-09-15 |