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 |