| NPI | 1548258932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 2475) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 22150) |
| 106H00000X Marriage & Family Therapist (Licence: TX 1550) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2007-07-08 |