| NPI | 1932766821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 79102) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 203122) |
| Enumeration Date | 2019-05-25 |
| Last Update Date | 2020-11-11 |