| NPI | 1609571439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0021356) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 84357) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2025-11-21 |