| NPI | 1497038830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 2373) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 64552) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2022-09-16 |