| NPI | 1942711825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 67603) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 15295) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CO37590616) | |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2024-08-05 |