| NPI | 1710737663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 109633) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 109633) |
| 101YM0800X Counselor, Mental Health (Licence: TX 109633) | |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2026-08-27 |