| NPI | 1225232168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 77413) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 1404) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2018-11-01 |