| NPI | 1780469866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 65341) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 10250) |
| 104100000X Social Worker (Licence: TX 23316) | |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2023-08-28 |