| NPI | 1700829736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 4071) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NM 54628) |
| 101YP2500X Counselor, Professional (Licence: TX 11287) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2024-10-15 |