| NPI | 1346494630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT# 1953) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL LmHC 2649) |
| 101YM0800X Counselor, Mental Health (Licence: FL LMHC 2649) | |
| 101YP2500X Counselor, Professional (Licence: FL LMHC 2649) | |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2008-11-13 |