| NPI | 1205986627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 4982451-3902) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LMFT-3504) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2012-04-24 |