| NPI | 1902224868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 10773) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 12851) |
| 106H00000X Marriage & Family Therapist (Licence: TX 908) | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2014-03-28 |