| NPI | 1154455913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH863) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT145) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |