| NPI | 1912419201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 10566387-3904) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2019-03-21 |