| NPI | 1356460414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 61340) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 200848) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2012-04-23 |