| NPI | 1023704632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 12121673-3902) |
| Additional Taxonomies | 225A00000X Music Therapist |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2025-10-09 |