| NPI | 1417223231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7775760-3502) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 7775760-3502) |
| 101YM0800X Counselor, Mental Health (Licence: UT 7775760-3502) | |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2016-09-26 |