| NPI | 1245556422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251B00000X Case Management (Licence: TX 63944) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 63944) |
| 101YM0800X Counselor Mental Health (Licence: TX 63944) | |
| 101YP2500X Counselor Professional (Licence: TX 63944) | |
| 171M00000X Case Manager/Care Coordinator (Licence: TX 63944) | |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2023-03-01 |