| NPI | 1205855947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 6313) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: FL MH 6313) |
| 103T00000X Psychologist (Licence: FL MH 6313) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |