| NPI | 1679813984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 77102) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 002284) |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2026-04-08 |