| NPI | 1396930178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TX 754) |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: TX 5914) |
| 106H00000X Marriage & Family Therapist (Licence: TX 113) | |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2007-09-13 |