| NPI | 1154310175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 1973) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 72518) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2022-09-20 |