| NPI | 1992828271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 3976) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 4251) |
| 103T00000X Psychologist (Licence: TX 31386) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2025-09-11 |