NPI | 1790711539 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IN 35000508A) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39000464A) |
Enumeration Date | 2006-06-23 |
Last Update Date | 2007-08-28 |