| NPI | 1669828828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT3602) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 4370) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2026-05-13 |