| NPI | 1972779379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 12720) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 99326) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2016-06-17 |