| NPI | 1073521258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 5622) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 0004460-039728) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2010-01-11 |