| NPI | 1093149866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701001955) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: VA 0812000038) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2017-02-10 |