| NPI | 1477066322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OR C6865) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 88695) |
| 101Y00000X Counselor (Licence: AR P1911138) | |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2024-07-18 |