| NPI | 1972801280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11176) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 66700) |
| 106H00000X Marriage & Family Therapist (Licence: TX 201583) | |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2011-03-10 |