| NPI | 1912031360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 10304) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 2072) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2011-11-16 |