| NPI | 1003966573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 6403) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 11378) |
| 106H00000X Marriage & Family Therapist (Licence: TX 1370) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2007-07-08 |