| NPI | 1700888625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 000013-041126) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 10611) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2025-09-11 |