| NPI | 1720305204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 7513046-6004) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: UT 7513046-6009) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2015-06-22 |