| NPI | 1205367265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 10760107-3902) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2024-07-23 |