| NPI | 1275158974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 9640257-3902) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 9640257-3904) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2024-08-06 |