| NPI | 1720750920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 3258) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 3258) |
| 101YP2500X Counselor, Professional (Licence: TX 3258) | |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2023-03-13 |