| NPI | 1477055507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 74530) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2021-02-24 |