| NPI | 1891153102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health (Licence: UT 10382594-3501) | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2024-06-12 |