NPI | 1578522074 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA LPC311) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA LMFT102) |
Enumeration Date | 2006-03-22 |
Last Update Date | 2007-07-08 |