| NPI | 1861774887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 12124) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: QABA QASP #8046) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2016-05-25 |