| NPI | 1750745055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 202561) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: TX 202561) |
| 103TF0000X Psychologist Family | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2023-10-03 |