| NPI | 1700473915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT4106) |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2024-02-22 |