| NPI | 1093113706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN 1139) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 201681) |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2014-12-11 |