| NPI | 1578118576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 76403) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 104263) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2020-09-24 |