| NPI | 1083339659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 79718) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2024045255) |
| Enumeration Date | 2022-10-06 |
| Last Update Date | 2026-08-29 |