| NPI | 1851317895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 8835) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 10968) |
| 106H00000X Marriage & Family Therapist (Licence: TX 1884) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2024-03-13 |