NPI | 1134464894 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 69958) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 6267) |
Enumeration Date | 2012-12-06 |
Last Update Date | 2012-12-06 |