| NPI | 1306530670 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health | 
| 251B00000X Case Management | |
| 172V00000X Community Health Worker (Licence: TX 14456) | |
| 171M00000X Case Manager/Care Coordinator | |
| 101YP1600X Counselor, Pastoral | |
| Enumeration Date | 2023-06-07 | 
| Last Update Date | 2025-09-09 |