| NPI | 1184769572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH0002757) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AK MT211) |
| 106H00000X Marriage & Family Therapist (Licence: FL MT0001487) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-07-08 |