| NPI | 1275629982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 93-117240-3902) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LMFT3111) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |