| NPI | 1801336953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT 32472) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 74788) |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2019-02-11 |