| NPI | 1477747343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH10056) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL MH 10056) |
| 106H00000X Marriage & Family Therapist (Licence: FL IMT516) | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2018-03-17 |