| NPI | 1518134956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 1-06-2680) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: FL 1-06-2680) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2008-05-14 |