| NPI | 1316647340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT4917) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SC TLC1287MFT) |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2025-09-26 |