| NPI | 1902319783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL IMT3779) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH M2100192) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2023-09-19 |