| NPI | 1992337182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 75485) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 75485) |
| 106H00000X Marriage & Family Therapist | |
| 101YM0800X Counselor, Mental Health (Licence: TX 75485) | |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2021-05-21 |