| NPI | 1225339351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ 16756) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 67105) |
| Enumeration Date | 2010-11-05 |
| Last Update Date | 2017-11-22 |