| NPI | 1053826453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 59556) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 13850) |
| 101YM0800X Counselor, Mental Health (Licence: TX 59556) | |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2017-12-07 |