| NPI | 1700111275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH9953) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL 9953) |
| 106H00000X Marriage & Family Therapist (Licence: FL MT3100) | |
| Enumeration Date | 2009-10-16 |
| Last Update Date | 2022-01-11 |