| NPI | 1255524153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: TX 27407 LMSW-IPR) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PR 5047) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2011-03-10 |