| NPI | 1184111924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 107840) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 14064) |
| 1041C0700X Social Worker, Clinical (Licence: NC C011404) | |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2024-06-14 |