| NPI | 1700324290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 204087) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY 0) |
| 106H00000X Marriage & Family Therapist (Licence: NY 001512) | |
| 106H00000X Marriage & Family Therapist (Licence: FL TPMF735) | |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2023-02-28 |