| NPI | 1538442744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 12595) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 31014) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2015-07-31 |