| NPI | 1346695129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 72305) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NV CP5692-R) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2025-04-21 |