| NPI | 1518129618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 78158) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AR P1009062) |
| 106H00000X Marriage & Family Therapist (Licence: TX 203038) | |
| 106H00000X Marriage & Family Therapist (Licence: AR M1201002) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2024-04-25 |