| NPI | 1154931616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 78424) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: TX 1507399) |
| Enumeration Date | 2020-08-08 |
| Last Update Date | 2023-09-10 |