NPI | 1740499920 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 6533) |
Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: NC 6533) |
Enumeration Date | 2007-05-22 |
Last Update Date | 2009-08-20 |