| NPI | 1801481155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 65210) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 14718) | |
| 101YM0800X Counselor Mental Health | |
| 101YP2500X Counselor Professional | |
| 103T00000X Psychologist | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2021-12-17 |