| NPI | 1174767016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 32614) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 22314) | |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2014-10-15 |