| NPI | 1700046497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 5010) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 16024) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2012-04-02 |