| NPI | 1285777318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 65444) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL 1029) |
| 101YP2500X Counselor, Professional (Licence: KS 354) | |
| 101YP2500X Counselor, Professional (Licence: CA 7656) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2022-09-28 |