| NPI | 1205363736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 10366581-3902) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: UT 10366581-3904) |
| 101Y00000X Counselor | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2019-07-18 |