| NPI | 1013614957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AZ 10842) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 204061) |
| Enumeration Date | 2023-02-10 |
| Last Update Date | 2023-02-10 |