| NPI | 1689455107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO LPCC.0023127) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 93089) |
| Enumeration Date | 2023-10-10 |
| Last Update Date | 2025-07-17 |