| NPI | 1083097398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 71875) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ME CC6582) |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2024-09-10 |