| NPI | 1447092598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 10853) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 15143) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2024-09-14 |