| NPI | 1639489412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT2443) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: 20696) |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2022-07-21 |