| NPI | 1063879534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 92218) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC007230) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2024-12-02 |