NPI | 1770801078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC1046) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC29326) |
101YM0800X Counselor, Mental Health (Licence: MD LC1046) | |
Enumeration Date | 2010-05-11 |
Last Update Date | 2010-05-11 |