| NPI | 1104998004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 406) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 505) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2015-06-03 |