| NPI | 1235261132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 5088) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2023-12-16 |