| NPI | 1730648841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT3079) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL MT3079) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MT3079) | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2019-04-08 |