| NPI | 1679840227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 203636) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA LMFT10000178) |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2024-08-05 |