| NPI | 1427818822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL IMT4070) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL IMT4070) |
| 101YM0800X Counselor, Mental Health (Licence: FL IMT4070) | |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2024-03-21 |