| NPI | 1336333194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 16114) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: IL 18599) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2007-09-04 |