NPI | 1912916826 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH6390) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT2222) |
Enumeration Date | 2006-08-07 |
Last Update Date | 2011-11-04 |