NPI | 1710012844 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 4708) |
Additional Taxonomies | 101YP2500X Counselor Professional (Licence: SC 4708) |
103TC2200X Psychologist Clinical Child & Adolescent (Licence: SC 688) | |
103TS0200X Psychologist School (Licence: SC 688) | |
Enumeration Date | 2007-02-22 |
Last Update Date | 2011-03-24 |