| NPI | 1861612434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 24122) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX LPC10755) |
| 106H00000X Marriage & Family Therapist (Licence: TX LMFT000157) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-07-08 |