| NPI | 1508877127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 915) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 22855) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2025-09-11 |