| NPI | 1801015185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MT2850) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT2850) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2022-02-22 |