| NPI | 1760875058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 72859) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.008826) |
| 101YP2500X Counselor, Professional (Licence: TX 67118) | |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2015-03-10 |