| NPI | 1003402090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0021389) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 78095) |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2025-05-19 |