| NPI | 1366789059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 6019771-3902) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: UT 6019771-3902) |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2021-06-17 |