| NPI | 1316384522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: TX 69109) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 69109) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2024-02-05 |