NPI | 1750759619 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 8069600-3501) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 64130) |
Enumeration Date | 2015-09-09 |
Last Update Date | 2025-07-14 |