| NPI | 1346465267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 264436-3501) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: UT 264436-3501) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: UT 27813) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2019-08-02 |