| NPI | 1083637938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 9451) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 7553) |
| 106H00000X Marriage & Family Therapist (Licence: TX 035207) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2025-09-11 |