| NPI | 1821704024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 104319) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 14755) |
| 104100000X Social Worker (Licence: TX 104319) | |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2025-03-17 |