| NPI | 1124698303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 201960) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 70008) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2021-06-29 |