| NPI | 1124420567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 8442856-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 8442856-6009) |
| 104100000X Social Worker (Licence: UT 8442856-3503) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2021-09-20 |