| NPI | 1639317068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 200944) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 18693) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2014-03-03 |