| NPI | 1730122979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 15380) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2021-03-29 |