| NPI | 1740210574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT2093) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH2406) |
| 101YP2500X Counselor, Professional (Licence: FL mh2406) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2024-04-08 |