| NPI | 1659911873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 102376) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 284036) |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2026-08-06 |