| NPI | 1245444538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 14284) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 14284) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2015-06-09 |