| NPI | 1164906632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 90399) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 12682) |
| 106H00000X Marriage & Family Therapist (Licence: CA 112536) | |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2023-10-17 |