| NPI | 1447840616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 83799) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 7450-125) |
| Enumeration Date | 2021-01-21 |
| Last Update Date | 2021-01-21 |