| NPI | 1649722414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL 3908) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health (Licence: FL IMT2839) | |
| 101YM0800X Counselor Mental Health (Licence: FL 18301) | |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2024-01-30 |