| NPI | 1548538432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT1072) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW2340) |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2011-12-06 |