| NPI | 1700282605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 07990) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 1351) |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2014-11-05 |