| NPI | 1649491564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 42670) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 10249) |
| 1041C0700X Social Worker, Clinical (Licence: TX 42670) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2025-09-11 |