| NPI | 1629460720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 204824) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 83773) |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2023-09-11 |