| NPI | 1467450965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 11072) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 003254) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2011-03-09 |