NPI | 1306057435 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 002280) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MO 2000161499) |
Enumeration Date | 2007-05-24 |
Last Update Date | 2007-07-08 |