| NPI | 1275836793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 07996) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 1246) |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2018-05-15 |