| NPI | 1164733994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 6212908-3902) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 6212908-3904) |
| Enumeration Date | 2010-06-26 |
| Last Update Date | 2019-07-22 |