| NPI | 1912757584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 92290) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 92290) |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2025-06-03 |