NPI | 1720303134 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 98464) |
Additional Taxonomies | 101Y00000X Counselor |
101YP2500X Counselor, Professional (Licence: OK 5004) | |
Enumeration Date | 2010-03-30 |
Last Update Date | 2025-05-27 |