| NPI | 1306823430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 200982) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 61305) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2010-08-25 |