| NPI | 1750627287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 8132029-3502) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 8132029-6006) |
| Enumeration Date | 2013-01-03 |
| Last Update Date | 2019-06-05 |