| NPI | 1568579902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701005728) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 11915) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-12-01 |