| NPI | 1851472567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 17682) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 1787) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2019-07-11 |