| NPI | 1760047625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 13607574-3904) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2024-08-11 |