| NPI | 1255499471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 19719) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 106H00000X Marriage & Family Therapist (Licence: TX 4923) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2025-03-20 |