| NPI | 1528490760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 11009876-6004) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 11009876-3902) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2024-03-09 |