NPI | 1841512001 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 3170) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT 1801) |
Enumeration Date | 2010-02-15 |
Last Update Date | 2010-02-15 |