| NPI | 1538547658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 87492) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 7685) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2023-04-11 |