| NPI | 1588398267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT4817) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2022-07-10 |
| Last Update Date | 2023-12-21 |