| NPI | 1538733779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT4096) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH19172) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2024-06-24 |