| NPI | 1750755104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT2700) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MT2700) |
| 171000000X Military Health Care Provider (Licence: FL MT2700) | |
| Enumeration Date | 2015-11-23 |
| Last Update Date | 2022-04-11 |