| NPI | 1366163917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID 9437) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 87245) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2023-04-05 |