| NPI | 1619338704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT3669) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OH M.1600009) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2020-03-31 |