| NPI | 1841421856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 61955) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 61955) |
| 101YM0800X Counselor, Mental Health (Licence: TX 61955) | |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2021-02-01 |