NPI | 1265649636 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 1127) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SC 1129) |
Enumeration Date | 2007-05-16 |
Last Update Date | 2007-07-08 |