| NPI | 1538716972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 83332) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TN 1486) |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2022-07-22 |