| NPI | 1568712925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 20196) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CO 0003004) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2012-09-13 |