NPI | 1013292663 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: FL MH 1184) |
Additional Taxonomies | 101Y00000X Counselor (Licence: FL MH 1184) |
101YM0800X Counselor, Mental Health (Licence: FL MH 1184) | |
106H00000X Marriage & Family Therapist (Licence: FL MT 801) | |
Enumeration Date | 2011-10-14 |
Last Update Date | 2011-10-14 |