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 |