| NPI | 1811984156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 74666) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701002011) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000437) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2016-07-20 |