| NPI | 1598116618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180.012047) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 76026) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2024-10-10 |