| NPI | 1174806434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMFT1612) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist (Licence: FL IMFT1612) | |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2019-08-13 |