| NPI | 1740313287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH8574) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA MAC507269 SAP13083) |
| 106H00000X Marriage & Family Therapist (Licence: FL MT2433) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2015-06-21 |