| NPI | 1437658697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 75222) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NY 015778) |
| 101YP2500X Counselor, Professional (Licence: AK 231648) | |
| Enumeration Date | 2018-02-02 |
| Last Update Date | 2025-11-29 |