| NPI | 1629718549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 88185) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2023-10-24 |