| NPI | 1770975591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX LPC77260) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA APC003974) |
| 101YP2500X Counselor, Professional (Licence: GA LPC008519) | |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2017-04-16 |