| NPI | 1871878140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT2918) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL imt1067) |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2022-12-05 |