| NPI | 1801159421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 203408) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor (Licence: OK 1161) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2026-05-29 |