| NPI | 1316062045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 1147) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 1011) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2025-09-11 |