| NPI | 1366818387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: PR 13242) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 14533) |
| 1041C0700X Social Worker, Clinical (Licence: TX 63523) | |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2024-10-16 |