| NPI | 1275741712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 5570057-3902) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IA 000354) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2018-07-25 |