NPI | 1134562903 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 7472928-3902) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NV 01235) |
Enumeration Date | 2013-04-11 |
Last Update Date | 2014-02-04 |