| NPI | 1942425640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TX 13701) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 13701) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-07-09 |