| NPI | 1164609152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 09314) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 000071) |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2009-12-10 |