| NPI | 1497153035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 202694) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166-000285) |
| Enumeration Date | 2014-12-14 |
| Last Update Date | 2016-06-15 |