| NPI | 1003024860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 65790) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MS 0469) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2011-01-24 |