| NPI | 1740391697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL MT2031) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL MH7601) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-12-21 |