| NPI | 1467708917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 9287734-3902) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-15128) |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2016-07-19 |