| NPI | 1760981286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 3774) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 17902) |
| Enumeration Date | 2018-02-10 |
| Last Update Date | 2018-02-10 |