| NPI | 1811692833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 16942) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 108857) |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2024-05-23 |