| NPI | 1700148392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 65840) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 65840) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2023-11-14 |