| NPI | 1043352396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717001378) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC001372) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2023-10-05 |