| NPI | 1073150512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT5227) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 11698340-3902) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2026-03-05 |