| NPI | 1790482180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 13194419-3902) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID 6271670) |
| Enumeration Date | 2023-02-15 |
| Last Update Date | 2026-02-17 |