| NPI | 1871066787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 93275) |
| Additional Taxonomies | 251B00000X Case Management |
| 101YP2500X Counselor, Professional (Licence: TX 93275) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2026-01-15 |