| NPI | 1992980650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 15278) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 2155) |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2007-12-31 |