| NPI | 1649371873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 13437) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 13437) |
| 106H00000X Marriage & Family Therapist (Licence: TX 4746) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2015-07-17 |