| NPI | 1417477035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL P12146) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT3863) |
| 106H00000X Marriage & Family Therapist (Licence: FL IMT2843) | |
| Enumeration Date | 2017-06-24 |
| Last Update Date | 2024-01-19 |