NPI | 1023216991 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 18408) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 5059) |
Enumeration Date | 2007-07-03 |
Last Update Date | 2024-01-25 |