| NPI | 1083198337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 77066) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 77066) |
| Enumeration Date | 2018-09-22 |
| Last Update Date | 2020-10-30 |