| NPI | 1619412665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C11112) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 10805) |
| 101YP2500X Counselor, Professional (Licence: IN 39005428A) | |
| 101YP2500X Counselor, Professional (Licence: LA 9458) | |
| 101YP2500X Counselor, Professional (Licence: IL 180.017657) | |
| 101YP2500X Counselor, Professional (Licence: MO 2015026792) | |
| 101YP2500X Counselor, Professional (Licence: TX 84270) | |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2026-01-09 |