| NPI | 1629627856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 76307) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2023-09-25 |