| NPI | 1013355692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: FL MH 10262) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH 10262) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2013-06-05 |