| NPI | 1760521165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX LPC 9354) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2015-06-26 |