| NPI | 1790791499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 7398) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 4110) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2017-03-16 |