| NPI | 1427244219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 203804) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 48558) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2021-03-01 |