| NPI | 1952450298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 7926) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 662) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 68395) | |
| 106H00000X Marriage & Family Therapist (Licence: LA 51) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |