| NPI | 1144927039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 54451) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: TX 9822) |
| 175T00000X Peer Specialist (Licence: TX 50044-1120) | |
| 175T00000X Peer Specialist (Licence: TX 1197-0120) | |
| 175T00000X Peer Specialist (Licence: TX 1814-0519) | |
| Enumeration Date | 2023-02-10 |
| Last Update Date | 2023-02-10 |