| NPI | 1164740759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 203280) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 838) |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2019-04-01 |