| NPI | 1144736240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 16344) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 64944) |
| Enumeration Date | 2017-12-27 |
| Last Update Date | 2022-11-21 |