| NPI | 1033358775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 99024) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC-5312) |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2025-08-04 |