| NPI | 1144637406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 17088) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 3122) |
| 273R00000X Psychiatric Unit (Licence: TX 17088) | |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2014-07-18 |