| NPI | 1184842171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 201356) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT 45692) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2019-10-14 |