| NPI | 1386291425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 10045) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 74898) |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2026-07-01 |