NPI | 1932177078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 1764) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 334) |
Enumeration Date | 2006-03-14 |
Last Update Date | 2007-08-21 |