| NPI | 1215056247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: UT 8111684-6004) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 60697) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2016-09-08 |