| NPI | 1174536619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0205461) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 16736) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2019-08-14 |