| NPI | 1902941073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 3347) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 3347) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2018-11-06 |