| NPI | 1972605483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT 2528) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY11342) |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2022-10-19 |