NPI | 1730561325 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 4734) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 92973) |
Enumeration Date | 2015-06-19 |
Last Update Date | 2024-12-10 |