| NPI | 1447600432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P2309009) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 72067) |
| 101YP2500X Counselor, Professional (Licence: CO 18233) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2026-03-05 |