| NPI | 1780351700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 105478) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 105478) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2024-01-04 |