| NPI | 1952557787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 200911) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 62058) |
| 106H00000X Marriage & Family Therapist (Licence: TX 200911) | |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2021-08-31 |