| NPI | 1184380222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 84754) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 21044) |
| 101YP2500X Counselor, Professional (Licence: NJ 37PC01200400) | |
| 101YP2500X Counselor, Professional (Licence: MO 2025008418) | |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2026-05-20 |