NPI | 1285904722 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701002516) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: VA 0803000036) |
Enumeration Date | 2011-12-30 |
Last Update Date | 2011-12-30 |