NPI | 1932256096 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39000734A) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35001337A) |
106H00000X Marriage & Family Therapist (Licence: KY 0138) | |
Enumeration Date | 2007-01-04 |
Last Update Date | 2014-09-03 |