| NPI | 1205837796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 18008) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 05119) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2013-08-15 |