| NPI | 1982094249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 204787) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 1167) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2022-10-07 |