NPI | 1548477615 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM LPCC1303) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NM LPCC1303) |
Enumeration Date | 2007-05-17 |
Last Update Date | 2007-07-08 |