| NPI | 1093045320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 4518) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 19228) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2010-01-08 |