| NPI | 1194580159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT5130) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL 3849) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2025-02-19 |