| NPI | 1619987633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 10830) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 10830) |
| 106H00000X Marriage & Family Therapist (Licence: TX 2596) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2024-05-10 |