| NPI | 1881909398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 66097) |
| Additional Taxonomies | 101Y00000X Counselor |
| 106H00000X Marriage & Family Therapist (Licence: TX 201642) | |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2024-03-21 |