| NPI | 1699839241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH247) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL SS149) |
| 106H00000X Marriage & Family Therapist (Licence: FL MT300) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2007-07-08 |