| NPI | 1629185327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MFT 2056) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: FL MHC 6306) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2015-07-16 |