| NPI | 1811463763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 202616) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LMFT48281) |
| Enumeration Date | 2018-10-18 |
| Last Update Date | 2025-02-12 |