| NPI | 1962010868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH22315) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL IMT3354) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2023-06-07 |