| NPI | 1861698599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 200875) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 61895) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2017-12-12 |