| NPI | 1912038480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 8837) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 8837) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 6165) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 673) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2013-03-21 |