| NPI | 1114260064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT 2841) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: FL MT2841) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2026-08-03 |