| NPI | 1396303046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 77184) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 203035) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2019-05-29 |