| NPI | 1447480876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 275550-3902) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: UT 15485) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2009-07-20 |