| NPI | 1649605965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 50020653902) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 106H00000X Marriage & Family Therapist (Licence: ID LMFT-6350) | |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2024-11-12 |