| NPI | 1548432172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 201058) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 66109) |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2016-07-14 |