| 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 |