| NPI | 1417407479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 5262995-3902) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 5262995-3904) |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2023-09-15 |