| NPI | 1134837149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT4508) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA MFT002358) |
| 106H00000X Marriage & Family Therapist (Licence: SC 8320) | |
| 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-16489) | |
| Enumeration Date | 2022-11-08 |
| Last Update Date | 2026-07-27 |