| NPI | 1043632110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 66009) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 7726) |
| 101YP2500X Counselor, Professional (Licence: CO LIC.0017658) | |
| Enumeration Date | 2014-01-09 |
| Last Update Date | 2024-05-24 |