| NPI | 1285051078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT 2758) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL MT 2758) |
| 101YM0800X Counselor Mental Health (Licence: FL MT 2758) | |
| 101YP2500X Counselor Professional (Licence: FL MT 2758) | |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2015-01-11 |