| NPI | 1851861439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11865) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: 56563) |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2021-12-02 |