| NPI | 1285102467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 13875) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 80281) |
| 104100000X Social Worker (Licence: TX 31461) | |
| Enumeration Date | 2018-11-06 |
| Last Update Date | 2023-05-08 |