| NPI | 1942778840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 203345) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 00002291) |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2023-02-14 |