| NPI | 1649263237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 5010) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 01452) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2007-07-08 |