| NPI | 1548991375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 91168) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MS 813) |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2023-05-04 |