| NPI | 1821686585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 202051) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 44086) |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2021-01-07 |