| NPI | 1831115534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 8532) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 8532) |
| 106H00000X Marriage & Family Therapist (Licence: TX 2087) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2007-07-09 |