| NPI | 1871730770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AR M1411009) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 4738) |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2016-09-13 |