| NPI | 1003687047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC.0021786) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 87311) |
| Enumeration Date | 2024-01-09 |
| Last Update Date | 2025-08-21 |