| NPI | 1649387374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 8900) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 243) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2026-02-20 |