NPI | 1740215987 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 4668) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 1185) |
Enumeration Date | 2006-07-12 |
Last Update Date | 2007-07-08 |