| NPI | 1346068376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 17088) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 17088) |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2026-07-18 |