| NPI | 1003872524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701002721) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000878) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2015-07-30 |