| NPI | 1548773062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 89459) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: SC COU.7523) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2024-08-27 |