| NPI | 1467504522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 1824) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 1591) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2011-05-19 |