| NPI | 1740285725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 18541) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 5226) |
| 106H00000X Marriage & Family Therapist (Licence: NM CTB-2024-0078) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2024-05-30 |