| NPI | 1053937383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 10716) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 20069) |
| 106H00000X Marriage & Family Therapist (Licence: TX 484) | |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2020-06-23 |