| NPI | 1023234713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 9704606-3902) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CT 001479) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2016-03-16 |