| NPI | 1518261056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT000906) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 608) |
| 106H00000X Marriage & Family Therapist (Licence: CO 509) | |
| Enumeration Date | 2010-12-25 |
| Last Update Date | 2012-02-12 |