NPI | 1285858910 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 13163) |
Additional Taxonomies | 103T00000X Psychologist (Licence: TX 14606) |
Enumeration Date | 2007-04-12 |
Last Update Date | 2008-08-15 |