| NPI | 1912901349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 2008) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 09975) |
| 106H00000X Marriage & Family Therapist (Licence: TX 001751-041825) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2007-07-08 |