| NPI | 1902287311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 73847) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2019-05-03 |