| 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 |