| NPI | 1538438874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 66423) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2024-06-13 |