NPI | 1700917341 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 6436) |
Additional Taxonomies | 103T00000X Psychologist (Licence: FL SS644) |
Enumeration Date | 2007-03-07 |
Last Update Date | 2007-07-08 |