NPI | 1083795082 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 00411) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 00411) |
Enumeration Date | 2006-10-17 |
Last Update Date | 2007-07-08 |