| NPI | 1881959880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 202565) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MD LCM532) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2022-11-15 |