| NPI | 1891142303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 6625) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 26111) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2016-05-16 |