| NPI | 1518456961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 202815) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 226797) |
| 106H00000X Marriage & Family Therapist (Licence: TX 202416) | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2018-05-01 |