| NPI | 1013051325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701001303) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000696) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2013-06-24 |