| NPI | 1477153187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH16592) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT1965) |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2022-03-02 |