NPI | 1861488322 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | |
Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MD 508) |
Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: MD 508) |
Enumeration Date | 2005-09-21 |
Last Update Date | 2007-07-08 |