| NPI | 1033682166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 4679) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 17969) |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2019-01-11 |