| NPI | 1467025536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C8035) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 14751) |
| 101YP2500X Counselor, Professional (Licence: TX 82350) | |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2026-07-21 |