| NPI | 1750528063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH19965) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2009-01-09 |
| Last Update Date | 2024-12-13 |