| NPI | 1588980635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 5079994-3902) |
| Additional Taxonomies | 253J00000X Foster Care Agency (Licence: UT 5079994-3902) |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2010-04-14 |