NPI | 1689600025 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 2557) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 172) |
Enumeration Date | 2006-06-25 |
Last Update Date | 2007-07-08 |