| NPI | 1477565802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 1104) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 4186) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2007-07-08 |