| NPI | 1063871515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 8906663-3902) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 8906663-3902) |
| 102L00000X Psychoanalyst (Licence: UT 8906663-3902) | |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2024-03-02 |