| NPI | 1700159852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 86348136004) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2024-04-12 |