| NPI | 1447622261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 9562) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 554) |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2015-10-21 |