| NPI | 1407157860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 347E00000X Transportation Broker | |
| 347C00000X Private Vehicle (Licence: TX 23840944) | |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2015-05-03 |