| NPI | 1457464083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 001012-040644) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 03521) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2007-07-08 |