| NPI | 1700451044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 347625-3904) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2026-02-27 |