| NPI | 1275198335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 203451) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701008193) |
| Enumeration Date | 2019-05-04 |
| Last Update Date | 2019-05-04 |