| NPI | 1164783932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 9783) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 1466) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2024-02-09 |