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 |