| NPI | 1730256090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TX 822) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 822) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2007-07-08 |