| NPI | 1881349348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX 108436) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL SW19335) |
| 101YM0800X Counselor Mental Health (Licence: FL SW19335) | |
| Enumeration Date | 2022-02-14 |
| Last Update Date | 2023-06-27 |