| NPI | 1760071088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 14834) |
| 101YM0800X Counselor, Mental Health (Licence: TX 66651) | |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2022-10-19 |