| NPI | 1609198399 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 65746) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK LPC05509) |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2022-08-04 |