| NPI | 1306973813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 05065) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 2499) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2007-07-08 |