| NPI | 1477597995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 16079) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-10-26 |