| NPI | 1841614161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 61553) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 201794) |
| Enumeration Date | 2014-02-06 |
| Last Update Date | 2022-06-27 |