| NPI | 1295603397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 86686) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 22440) |
| Enumeration Date | 2025-10-29 |
| Last Update Date | 2025-10-29 |