| NPI | 1275911158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 202360) |
| Additional Taxonomies | 171W00000X Contractor (Licence: TX 202360) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2020-01-17 |