| NPI | 1720163132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 30420) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 16199) |
| 101YM0800X Counselor, Mental Health (Licence: TX 15246) | |
| 101YP2500X Counselor, Professional (Licence: TX 15246) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2023-06-05 |