| NPI | 1407469075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 8708) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 76905) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2025-06-20 |