| 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: FL 3154) |
| Enumeration Date | 2022-11-08 |
| Last Update Date | 2022-11-21 |