| NPI | 1376788596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 3009) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 11132) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2012-03-06 |