| NPI | 1942351374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 11846) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 4022-034524) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2008-09-25 |