NPI | 1962680132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 3248) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 776) |
Enumeration Date | 2008-02-09 |
Last Update Date | 2008-02-10 |