| NPI | 1245474543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 201311) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 0001399) |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2024-01-16 |