| NPI | 1043823354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 203696) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 108500) |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2024-10-14 |