| NPI | 1770881161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 65507) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2024-07-03 |