| NPI | 1427268309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT 1871) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH 2445) |
| 103K00000X Behavior Analyst (Licence: FL 1-01-0566) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2010-09-09 |