NPI | 1275648669 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 1183) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 11022) |
106H00000X Marriage & Family Therapist (Licence: TX 2028) | |
Enumeration Date | 2006-08-19 |
Last Update Date | 2007-07-08 |