| NPI | 1235270729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH515) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT169) |
| 163W00000X Registered Nurse (Licence: FL RN1055402) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2007-07-08 |