| NPI | 1194867689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701005755) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 15632) |
| 101YP2500X Counselor, Professional (Licence: NM 0141561) | |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0012900) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2024-07-17 |