| NPI | 1821438359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 7993) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 88106) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2022-11-28 |