| NPI | 1699813618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 469) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 551) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2018-06-21 |