| NPI | 1922344316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 201977) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 12578581-3902) |
| Enumeration Date | 2012-12-13 |
| Last Update Date | 2025-09-25 |