| NPI | 1376080952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 10648665-3904) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2018-03-17 |