| NPI | 1972676963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 3109) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 19687) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2024-03-05 |