| NPI | 1922470467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT3984) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 10111946-3902) |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2024-03-22 |