| NPI | 1528269453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 110) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 2948) |
| 101YP2500X Counselor, Professional (Licence: 216808) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2007-07-20 |