| NPI | 1285299966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 85156) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC60943656) |
| 101Y00000X Counselor | |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2021-04-19 |