| NPI | 1124265053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AR P00610054) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 18091) |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2009-01-14 |