| NPI | 1104663921 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 87166) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LPC-9557) |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2024-07-09 |