NPI | 1568674125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 1999) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 11544) |
106H00000X Marriage & Family Therapist (Licence: LA MFT 44) | |
106H00000X Marriage & Family Therapist (Licence: TX 2707) | |
Enumeration Date | 2007-05-04 |
Last Update Date | 2007-07-08 |