| NPI | 1144570706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 10321-125) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 67731) |
| 101YP2500X Counselor Professional (Licence: CO LPC.0012689) | |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2023-10-31 |