| NPI | 1942563903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 2042) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WV 2042) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 61815) | |
| 101YP2500X Counselor, Professional (Licence: TX 61815) | |
| 106H00000X Marriage & Family Therapist (Licence: WV 2042) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 61815) | |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2012-06-24 |