| NPI | 1881283828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 204988) |
| Additional Taxonomies | 183700000X Pharmacy Technician |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2025-06-19 |