| NPI | 1013127448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NM 0427) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 1415) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |