| NPI | 1659623783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 201872) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY6944) |
| Enumeration Date | 2012-10-13 |
| Last Update Date | 2012-10-13 |