| NPI | 1942906201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT3349) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60537148) |
| Enumeration Date | 2023-02-07 |
| Last Update Date | 2023-02-07 |