| NPI | 1598162919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 71462) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 99401) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2014-12-01 |