NPI | 1366658825 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: DE 0000002) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717001110) |
106H00000X Marriage & Family Therapist (Licence: PA MF000287) | |
Enumeration Date | 2007-05-14 |
Last Update Date | 2012-03-08 |