NPI | 1467541706 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701002567) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000495) |
Enumeration Date | 2006-10-12 |
Last Update Date | 2007-07-08 |