| NPI | 1942564810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251B00000X Case Management (Licence: TX 68829) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 68829) |
| 171M00000X Case Manager/Care Coordinator (Licence: TX 68829) | |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2023-03-01 |