| NPI | 1992205306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MCAP100057) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL IMT4132) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX LCDC16433) | |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2024-04-29 |