| NPI | 1245348002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX S00483) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 2968) |
| 106H00000X Marriage & Family Therapist (Licence: TX 002808) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2021-09-27 |