| NPI | 1871026633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 202536) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 73743) |
| Enumeration Date | 2017-04-09 |
| Last Update Date | 2025-09-19 |