| NPI | 1891309019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 81051) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 81051) |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2025-03-13 |