| NPI | 1396731378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 9319) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180005069) |
| 106H00000X Marriage & Family Therapist (Licence: FL MT 2284) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2010-09-30 |