| NPI | 1679946099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 75023) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 75023) |
| Enumeration Date | 2015-11-06 |
| Last Update Date | 2024-06-14 |