| NPI | 1881356707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2021048302) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 82694) |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2023-08-23 |