| NPI | 1114973823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: FL MH0000454) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: FL MH0000454) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2010-09-08 |