| NPI | 1639883929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: GA MSW008866) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX MSW008866) |
| 106S00000X Behavior Technician | |
| 171M00000X Case Manager/Care Coordinator (Licence: TX 1268679823) | |
| 251S00000X Community/Behavioral Health (Licence: TX 1268679823) | |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2023-06-19 |