| NPI | 1407479496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT3506) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CT 002899) |
| Enumeration Date | 2020-05-25 |
| Last Update Date | 2024-09-12 |