| NPI | 1760437990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 1991) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT 1214) |
| 183500000X Pharmacist (Licence: FL PS19571) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2024-01-02 |