| NPI | 1801500228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 105557) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 56474) |
| 1041C0700X Social Worker, Clinical (Licence: AK 250613) | |
| Enumeration Date | 2023-01-10 |
| Last Update Date | 2026-06-11 |