| NPI | 1164016150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DC PRC15434) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 90945) |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2023-04-05 |