| NPI | 1053851527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 73514) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA PCCI3743) |
| Enumeration Date | 2017-03-03 |
| Last Update Date | 2021-11-23 |