| NPI | 1043754534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701010297) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 73986) |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2022-08-04 |