| NPI | 1710212329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 202647) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 50798) |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2015-10-30 |