| NPI | 1740897339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 204936) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA PLC8084) |
| 106H00000X Marriage & Family Therapist (Licence: LA PLM1381) | |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2024-01-05 |