| NPI | 1386209401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 16226) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-38931) |
| 104100000X Social Worker (Licence: MT BBHSWLCLIC44815) | |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2023-01-04 |