| NPI | 1467581793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 13939) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 5001) |
| Enumeration Date | 2007-03-04 |
| Last Update Date | 2025-09-11 |