| NPI | 1417201500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 201808) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 68742) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2021-06-14 |