| NPI | 1699844407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NM 1192) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 13788) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2008-09-08 |