NPI | 1306025713 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 2414) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA MFT122) |
Enumeration Date | 2007-11-01 |
Last Update Date | 2007-11-01 |