| NPI | 1225358229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 4377) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 63169) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2015-02-04 |