| NPI | 1780389833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA MC61351988) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 92900) |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2024-09-20 |