| NPI | 1003917816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 2622) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 11188) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2025-09-11 |