| NPI | 1356575732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 13225) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 0071841) |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2009-05-13 |