| NPI | 1174551451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 62915) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 1572) |
| 106H00000X Marriage & Family Therapist (Licence: TX 201142) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2010-04-06 |