| NPI | 1700180163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 2691) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 203742) |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2023-09-29 |