| NPI | 1720931017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 14164528-6009) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 14164528-3904) |
| Enumeration Date | 2026-02-17 |
| Last Update Date | 2026-02-17 |