| NPI | 1578102281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 68804) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 8153) |
| Enumeration Date | 2019-12-27 |
| Last Update Date | 2025-12-12 |