| NPI | 1922586908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 14643) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 76462) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2018-09-17 |