| NPI | 1477695500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 35518) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 7110) |
| 101YP2500X Counselor, Professional (Licence: TX 61446) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |