| NPI | 1457579047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 9012) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT2357) |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2009-12-09 |