| NPI | 1083745301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 1567) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP 1654) |
| 106H00000X Marriage & Family Therapist (Licence: FL MT 1385) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2013-04-23 |