| NPI | 1265401491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT1756) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH3082) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2025-09-11 |