| NPI | 1780049908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 8891137-3902) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 8891137-3904) |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2019-02-14 |