NPI | 1447092598 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 108053) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 15143) |
Enumeration Date | 2024-06-10 |
Last Update Date | 2025-07-21 |