| NPI | 1720264302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0021059) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 70020) |
| 101YP2500X Counselor, Professional (Licence: VA 0710102179) | |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2025-03-18 |