NPI | 1275629982 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 93-117240-3902) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LMFT3111) |
Enumeration Date | 2006-10-04 |
Last Update Date | 2007-07-08 |