NPI | 1881853174 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 2502) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 266) |
Enumeration Date | 2008-06-03 |
Last Update Date | 2011-06-21 |