| NPI | 1891731501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 000634) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 1121) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2025-09-11 |