| NPI | 1982680344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 9493) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 001278) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2023-11-03 |