| NPI | 1477843241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2011009728) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 78520) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2025-11-20 |