| NPI | 1700072147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 10118487-3902) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LMFT43623) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2016-10-18 |