| NPI | 1700773702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 206014) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 99117) |
| Enumeration Date | 2025-06-23 |
| Last Update Date | 2025-11-11 |