| NPI | 1043082308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WA MG61482611) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 205158) |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2023-10-30 |