| NPI | 1285867747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 15689) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 4780) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2009-09-01 |