| NPI | 1578597084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 302) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 101YM0800X Counselor, Mental Health (Licence: TX 9866) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-07-15 |