| NPI | 1508917956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 60121) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 201037) |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2024-10-15 |