| NPI | 1043327794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH6603) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT1678) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2007-07-08 |