| NPI | 1619407319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 11407) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 11407) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2021-01-14 |