| 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 |