| NPI | 1760927693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 85371) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MO 2019037119) |
| Enumeration Date | 2017-01-02 |
| Last Update Date | 2023-05-25 |