| NPI | 1790543858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPCC.0021552) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 13875359-6009) |
| Enumeration Date | 2024-03-12 |
| Last Update Date | 2024-05-10 |