| NPI | 1952141509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701015917) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 94906) |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2026-04-22 |