| NPI | 1003392598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL IMT4178) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2025-02-25 |