| NPI | 1467501643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6401000096) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 10615) |
| 106H00000X Marriage & Family Therapist (Licence: TX 000234) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |