NPI | 1083798318 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 9552) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 004483-0409) |
Enumeration Date | 2006-10-24 |
Last Update Date | 2022-09-15 |