NPI | 1861007452 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 81633) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 15092) |
Enumeration Date | 2020-09-10 |
Last Update Date | 2021-09-08 |