| NPI | 1275046997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 74721) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 74721) |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2022-06-22 |