| NPI | 1588969190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7567279-3501) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 75672796005) |
| 104100000X Social Worker (Licence: UT 7567279-3502) | |
| Enumeration Date | 2011-01-13 |
| Last Update Date | 2022-07-11 |