| NPI | 1225321334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 201530) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 65389) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2012-06-18 |