| NPI | 1588633754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P8811023) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 8751) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2011-06-23 |