NPI | 1982808911 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: NC 2085) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NC 1637) |
Enumeration Date | 2007-06-13 |
Last Update Date | 2007-07-08 |