| NPI | 1225193261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX LCSW 23834) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: TX 23834 LCSW) |
| 101YP2500X Counselor, Professional (Licence: TX 14943) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX LCDC 797) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2014-03-03 |