| 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 |