| NPI | 1851557367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 3786) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT 1745) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2013-06-11 |