| NPI | 1831402551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 7552) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 73157) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2025-02-21 |