| NPI | 1659150076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT5092) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA MFT002256) |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2026-04-07 |