NPI | 1073659801 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 229-124) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IA 00170) |
Enumeration Date | 2007-01-29 |
Last Update Date | 2007-07-08 |