| NPI | 1639530215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 95036) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.015589) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2024-09-10 |