| NPI | 1952575151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 18578) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 946) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2011-03-18 |