| NPI | 1811881089 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 114704) | 
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 72986) | 
| Enumeration Date | 2025-06-04 | 
| Last Update Date | 2025-06-20 |