| NPI | 1932205705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 5254) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 3617) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2019-04-24 |