| NPI | 1275878167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 54685) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11695) |
| 104100000X Social Worker (Licence: TX 54685) | |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2020-12-20 |