| NPI | 1922194034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 3157) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 11288) |
| 101YP2500X Counselor, Professional (Licence: NC 2139) | |
| 101YP2500X Counselor, Professional (Licence: LA 2075) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 2683-002737) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-08 |