| NPI | 1184766743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 200752) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 18763) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2013-09-09 |