| NPI | 1871656546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 11613) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 4169) |
| 106H00000X Marriage & Family Therapist (Licence: TX 4555) | |
| Enumeration Date | 2006-12-17 |
| Last Update Date | 2009-08-27 |