| NPI | 1992412530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 89400) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 81522) |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2025-01-21 |