| NPI | 1427344506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH9575) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSY-2721) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2012-06-08 |