| NPI | 1942176573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 100158) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 206238) |
| Enumeration Date | 2025-10-13 |
| Last Update Date | 2025-10-29 |