| NPI | 1922884386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 92252) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0022858) |
| Enumeration Date | 2023-09-01 |
| Last Update Date | 2025-09-17 |