| NPI | 1255602900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 3195) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 7701) |
| 101YP2500X Counselor, Professional (Licence: TX 7701) | |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2012-01-25 |