| NPI | 1245633908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 56903) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 12891) |
| 104100000X Social Worker (Licence: TX 56903) | |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2016-10-07 |