NPI | 1073726915 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 68-0000089) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC20279) |
Enumeration Date | 2007-05-07 |
Last Update Date | 2007-07-08 |