| NPI | 1942449541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 13082) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 8441446-6008) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 117) | |
| 101YM0800X Counselor, Mental Health (Licence: UT 8441446-6004) | |
| 101YP2500X Counselor, Professional (Licence: CO 2667) | |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2023-12-19 |