| 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 |