| NPI | 1467996603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 76196) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180007780) |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2020-01-30 |