| NPI | 1013680636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 83367) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 12573) |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2026-02-11 |