| NPI | 1083937619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 2524-2142) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 2524-2142) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2013-01-02 |