| NPI | 1063961357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 6267) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 14492) |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2016-10-12 |