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 |