NPI | 1205855947 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 6313) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: FL MH 6313) |
103T00000X Psychologist (Licence: FL MH 6313) | |
Enumeration Date | 2006-07-19 |
Last Update Date | 2007-07-08 |