| NPI | 1659137792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 14271132-3902) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS LCMFT03386) |
| 106H00000X Marriage & Family Therapist (Licence: MO 2025003128) | |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2026-02-27 |