| NPI | 1023413820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 202590) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA MG60305618) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2017-04-20 |