| NPI | 1952532962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 13062) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 314) |
| 106H00000X Marriage & Family Therapist (Licence: TX 4503) | |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2020-07-15 |