| NPI | 1841744414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 63841) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 10005) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 508282) | |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2016-08-11 |