| NPI | 1922579101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 206000) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 1481-124) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2025-09-19 |