| NPI | 1366961369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 090358) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 61498) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 13915) | |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2025-10-06 |