| NPI | 1679212310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: UT 141185-3501) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: UT 141185-3501) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2022-06-01 |