| NPI | 1932303278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 13183) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 81877L) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2019-03-25 |